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Shoulder dystocia

Shoulder dystocia is a vaginal head delivery that requires additional obstetric maneuvers to deliver the fetus after the head has delivered and gentle traction has failed. Some studies have called prolongation of head-to-body delivery time of more than 60 seconds.

Why is shoulder dystocia

  1. The incidence of shoulder dystocia is high in huge infants above 4 kilograms.
  2. Diabetic mothers, the torso of the fetus will grow faster than the fetal head, and the shoulder, chest, and head ratio will be asymmetric.
  3. Expectant mother’s pelvic stenosis, if the flat pelvis is prone to shoulder dystocia, pelvic tilt is too large, or the position of the pubic symphysis is too low.
  4. The long duration of the second stage of labor is also prone to shoulder dystocia.

What are the risks of shoulder dystocia?

  1. The fetal shoulder is stuck in the birth canal, the blood in the umbilical cord will be compressed , leads to hypoxia
  2. The brain may be damaged due to hypoxia, resulting in permanent brain damage.
  3. Clavicle fracture and brachial plexus nerve injury may occur.
  4. Due to prolonged labor, it may lead to weak uterine contractions or tears in the uterine ostium, resulting in more postpartum hemorrhage.
  5. Atrophy of the reproductive tract and puerperal infection.

How to deal with shoulder dystocia

When shoulder dystocia occurs, it must be calm. Generally, doctors need to cut the vulva side and use anesthetics, and then take the following five methods to help birth.

  1. Thigh flexion method: Mainly let the mothers flex their legs as close as possible to the abdomen, hold the knees with both hands, reduce the pelvic inclination and make the lumbosacral anterior concave straight.
  2. Anterior shoulder pressing method: The doctors will press on your abdomen just above the pubic bone to try to release your baby’s shoulder.
  3. Shoulder rotation method: When the back shoulder of the fetus has been put into the basin, your obstetrician or midwife will put his or her hand within the vagina to try to free your baby’s shoulder,
  1. Pull back arm method: Place the physician’s hand in the vagina and locate the posterior arm.  The fetal elbow is flexed, and the forearm is delivered in sweeping motion over the anterior chest wall.
  2. Cleidotomy: If the above four methods are not effective, you can cut the fetal clavicle and sew soft tissue after delivery, and the clavicle will heal itself.

How to prevent shoulder dystocia

In most instances, shoulder dystocia cannot be prevented because it cannot be predicted.

If you have diabetes or have developed diabetes in pregnancy, you will usually be offered early induction of labour or planned caesarean section. This will reduce the risk of shoulder dystocia.

If you don’t have diabetes, early induction of labour does not prevent shoulder dystocia, even if your baby is suspected to be large. Caesarean section is also not routinely recommended in this situation.

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